Is being a whistle-blower worth it?

Monday

Nov 26, 2007 at 12:01 AMNov 26, 2007 at 11:44 PM

Antoinette Menapace helped the federal government uncover millions of dollars in health care fraud. She isn’t a doctor, a lawyer or a cop. She’s a grandmother and former medical coder who didn’t think the numbers added up. Being a whistle-blower has come with personal costs. Menapace spent a year and a half out of work. She and her husband lost their home of 25 years in foreclosure.

She isn’t a doctor, a lawyer or a cop. She’s a grandmother and former medical coder who didn’t think the numbers added up.

Almost two years ago, she filed a lawsuit against her former employer, Dr. Mohammed Aiti, claiming he and other doctors at Premier Medical Group were billing government and private insurance companies for unnecessary heart-related tests.

The FBI and federal prosecutors took up the case, which led to Aiti’s conviction, the end of his medical career and the forfeiture of close to $1.9 million. Aiti is to be sentenced Jan. 10. He faces up to five years in prison and a $250,000 fine.

Being a whistle-blower has come with personal costs. Menapace spent a year and a half out of work. She and her husband lost their home of 25 years in foreclosure.

Now, with the help of her lawyers, the 49-year-old Canton woman is in court with hopes of getting a portion of the forfeiture, but it’s not a sure thing.

“The government is trying to encourage people like Antoinette to come forward, but at the end there might not be anything,” said attorney Elizabeth Raies.

Not adding up

Menapace started working for Premier in 2004. The practice had offices in Canton, Massillon, Dover and Cleveland. Aiti, a cardiologist, ran the show, and after three months on the job, Menapace started to question his billing methods.

Before patients came to the office they were flagged for expensive heart-related tests as often as their insurance would pay for them.

“Even if they were coming in for a sore throat,” Menapace said.

Most of the patients were older and didn’t question the tests, one of which was a stress test involving the injection of radioactive dye. When a patient had qualms, Premier staffers would say the test was a safeguard and that they wouldn’t have to pay out of pocket. Few refused.

To justify further tests, Aiti altered results.

“I kept picturing my parents, who were elderly, and a doctor doing this to them,” Menapace said. “And it just wasn’t right.”

When employees, including other Premier doctors, questioned his orders, Aiti became irate, Menapace said. He also coerced doctors who depended on Premier to sponsor their work visas, according to court papers.

She recalled an angry exchange between Aiti and a female doctor who wouldn’t order a stress test.

“The lady is pregnant. I am not going to have her have a stress test,” Menapace recalled the female doctor telling Aiti. That doctor eventually left the practice.

While Menapace didn’t like what she saw, she also doubted herself. Maybe she misunderstood the billing process. But when she consulted her medical billing instructor in Canton City Schools’ adult education program, the instructor shared her concerns.

Menapace got a job as a medical coder in another office, although she was laid off six months later and spent the next year and a half unemployed.

During that time, she lost her home.

She also contacted lawyers who took up her case.

“When she came to us, we said, 'All right, are you sure?’” attorney Lee Plakas said.

Menapace had documents to back her claims, including altered test results she picked from Premier’s trash and a sheet that showed employees how to match diagnosis and test codes to secure insurance payments.

Qui tam

“Qui tam”: It’s an abbreviation of a Latin phrase meaning, “Who sues on behalf of a king as well as for himself.” America doesn’t have kings, but in federal law, it’s the government’s way of encouraging citizens to sue when they suspect graft.

In return for their work, whistleblowers under the federal False Claims Act get a share of any money recovered. In fiscal year 2007, whistleblowers helped the federal government recover $1.45 billion and received $177 million for their work, according to the Justice Department.

Plakas, Raies and attorney Megan Frantz went to work on Menapace’s claim.

With her help they located former Premier employees. Some would help, others wouldn’t.

It took nearly a year to build the lawsuit, which remained under seal as federal agents conducted a criminal investigation. Aiti, his wife and another doctor were indicted. On the eve of trial, Aiti pleaded guilty.

Charges were dropped against his co-defendants.

Menapace was relieved. She’s working again and has stopped having nightmares about her old job, she said. But the case isn’t over for her.

The government could try to get more money out of Aiti through a civil action but isn’t. That’s a sign there isn’t much left for Menapace to recover on her own, Frantz said.

So Menapace is seeking between 15 and 25 percent of the government’s share of the forfeiture. Her attorneys would get part of that. Private insurance companies may also have claims for restitution.